BFR & COVID19.  Should we be using cuffs on positive COVID Patients?

Many of us love using BFR with our clients and patients.  Using BFR and light loads has been shown to improve muscle strength, size and aerobic capacity.  Like any activity, there are some risk associated with BFR because of the tourniquet used to decrease blood flow to the limb.
Additional risks are associated when individuals have known clotting issues.  COVID19 is one of the conditions that increases ones risk for blood clotting.

BLOOD CLOTS & COVID-19

A well know fact about COVID-19 is the increased risk for blood clots.  COVID-19-associated coagulopathy is common in patients with COVID-19 and can cause high rates of thrombotic complications that increase the morbidity and mortality rates.(Poggiali 2020) Increased levels of D-dimer protein with normal fibrinogen levels are the hallmark laboratory findings and correlate with severity of illness and risk of thrombosis. Patients with very high D-dimer levels (6 times the upper limit of normal, greater than 3,000 ng/mL) have the greatest risk of thrombosis.  These high D-dimer protein levels are usually found in those patients with severe symptoms related to COVID-19.

BFR & COVID19

Care and consideration of using BFR tourniquets on those patients or clients who have been diagnosed with COVID-19 is essential due to the known blood clot risk. Although there are no known cases of thrombosis after the use of BFR tourniquets in a COVID-19 diagnosed individual, care should be taken prior to using BFR on someone who tested positive for COVID-19.
For example, elective surgery is being delayed two weeks after diagnosis of COVID-19 to allow the return to normal blood clotting and reduce the risk of blood clots after surgery.

BFR RECOMMENDATIONS:

If your client or patient has been diagnosed with COVID-19, differentiate those individuals with severe symptoms and those with no or minor symptoms.  Minor symptoms would be similar to the symptoms experienced during a normal flu.

If no or minor symptoms – BFR training can take place after 2 weeks of the positive test result.

  • Keep inflation times to less than 10 minutes then allow for free flow (no pressure) for at least a minute.
  • Do not perform Ischemic Pre-Conditioning protocol (100% LOP) for 4 weeks post diagnosis.
  • After 4 weeks, normal BFR training, including long aerobic capacity sessions (20 minutes) can return.

If severe symptoms – No BFR training should commence for at least 4 weeks after a positive test result.
Keep inflation times to less than 10 minutes then allow for free flow for at least a minute.
Do not perform Ischemic Pre-Conditioning protocol (100% LOP) for 8 weeks post diagnosis.
After 8 weeks, normal BFR training, including long aerobic capacity sessions (20 minutes) can return.

CONCLUSION:

More than ever it is important to know how much pressure we are using when performing BFR.  Having BFR cuffs that are wide (>5cm) and can establish arterial occlusion pressure (aop), allows for individualized pressures and reduced risk of injury or clotting.  Using narrow cuffs (<5cm wide) and higher pressures increase the risk and should be avoided.

APPENDIX:

Fibrinogen – Fibrinogen is a soluble protein in the plasma that is broken down to fibrin by the enzyme thrombin to form clots.  Normal Range: Adult: 200-400 mg/dL or 2-4 g/L (SI units)

D-Dimer Protein – A small protein fragment present in the blood after a blood clot is degraded by fibrinolysis. D-dimers are not normally present in human blood plasma, except when the coagulation system has been activated, for instance because of the presence of thrombosis or disseminated intravascular coagulation.

Coagulopathy – Coagulopathy is a condition in which the blood’s ability to clot is impaired.

Arterial Occlusion Pressure (aop) – The least amount of pressure necessary to completely occlude both venous and arterial blood flow to the limb.

REFERENCES:

1. Poggiali E, Bastoni D, Ioannilli E, Vercelli A, Magnacavallo A. Deep Vein Thrombosis and Pulmonary Embolism: Two Complications of COVID-19 Pneumonia? Eur J Case Rep Intern Med. 2020 Apr 8;7(5):001646. doi: 10.12890/2020_001646. PMID: 32399449; PMCID: PMC7213837.

2. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus 133 in Wuhan, China. Lancet. 2020;395(10223):497–506.

3. Zheng YY, Ma YT, Zhang JY, Xie X. COVID-19 and the cardiovascular system. Nat Rev Cardiol. 2020 Mar 5; doi: 10.1038/s41569-020-0360-5.

Font Resize
Contrast